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the Evergreen <br />CITY OF C*4NSTRUCTION <br />ever eft PERMIT PERMIT NO. 19640 <br />F DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL fL1 PLUMBING ❑ SIGN <br />:.NER MAIL ADDRESS CITY ZIP PHONE <br />Everett School Dist. #2 4730 Colby Ave. Everett, WA 98201 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br />MECHANICAL CONTRACTOR MAIL ADDRESS CIT' ZIP PHONE LICENSE 7 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE II <br />Gerrick Co. Inc. 1511 S. Centrai Kent 98032 854-3350 GERRIC171RB <br />❑ NEW •V EkADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION — <br />VALUATION OF WORK <br />Z <br />Plumbing restroom's - Hydronic Heating, repipe boiler zoom. <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Little Theater <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMP; IED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />5TAf1ff--(51:t,L@CAL LAW REGULATING CONSTRUCTION OR <br />HE PERFORK%NrVE OF O UC ION. <br />SIGNATURE OF LONT AC R,AU O D GE . OWNER DATE <br />� <br />LEGAL DESCRIPTION OF PROPERTY (SHOW BELOW OR ATTACH FOUR COPIES) <br />LOT — BLOCK _— OF <br />JOB ADDRESS 15CI <br />16" 24th St. <br />PLUMBING <br />MECHANI AL <br />NO. <br />TYPE OF FIXTURE OR ITEM, <br />FEE <br />NO. I <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />'�. <br />-.➢I <br />A/C — A/HNDLG UNITS —H.P. <br />BATHTUB <br />_ <br />REFRIGERATION UNITS — H.P. EA. <br />5 <br />LAVATORY (WASH BASIN) <br />ZS <br />OO <br />BOILERS — B.T.U./H.P. <br />SHOWER <br />GAS FIRED A.C. UNITS — B.T.U. <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS — B.T.U. M F.A. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — BS.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />lO <br />00 <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />20 <br />00 <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR, ETC.) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />_ <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />S <br />PERMIT <br />S <br />PERMIT <br />TOTALFEE <br />$ <br />- <br />TOTALFEE <br />S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CF'ECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />DYES ❑No <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />10$ <br />00 <br />SIZE OF B*.DG. <br />NO. OF STORIES <br />MAX. OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ONO <br />INVESTIGATION FEE <br />Sea 304(e) <br />STATE BUILDING SURCHARGE <br />;6. <br />STATE ENERGY SURCHARGE <br />APPLICMTION ACC. BY <br />S.H. <br />PLANS CHECKED BY - <br />_ <br />APPR FOR ISSUANCE BY <br />DRIVEWAY PERMIT <br />TOTAL <br />10$ <br />00 <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />d- <br />CJ0 <br />Q7 <br />ADDRESS FILE <br />